The candidate seeks to further his career in patient-oriented research involving osteopathic manipulative treatment (OMT). The K24 Award will enable the candidate to meet this goal by providing protected time and resources to: (1) undertake career development activities involving OMT techniques, including their mechanistic and clinical aspects; (2) mentor beginning clinician investigators; and (3) conduct a clinical trial of OMT for chronic low back pain. Career development activities will be available on the campus of the University of North Texas Health Science Center (UNTHSC) through: (1) health professional and graduate courses offered by the Texas College of Osteopathic Medicine, the Graduate School of Biomedical Sciences, and the School of Public Health; and (2) research collaborations with other investigators within the national Osteopathic Research Center. Off-campus education and training will be available through the American Academy of Osteopathy. Mentoring relationships will be established with an estimated 20 beginning clinician investigators at UNTHSC during the K24 Award period. These investigators will include postdoctoral clinical research fellows and junior faculty members in osteopathic manipulative medicine and osteopathic primary care specialties. Investigators will have access to the candidate's research databases and the opportunity to participate in his ongoing patient-oriented research, including, but not limited to, the clinical trial described below. The candidate proposes to determine the efficacy of OMT for chronic low back pain. This objective will be met by achieving three specific aims: (1) comparing the efficacy of OMT provided by predoctoral osteopathic manipulative medicine fellows and licensed osteopathic physicians; (2) comparing the relative utility of sham manipulation and sham ultrasound as placebo control treatments in OMT trials; and (3) using the results of Specific Aims 1 (OMT arm) and 2 (placebo control treatment arm) to guide the completion of a randomized clinical trial of OMT for chronic low back pain.